Multidisciplinary management of locally advanced and metastatic cutaneous squamous cell carcinoma.

J Claveau,J Archambault,F Parent,D S Ernst,J J Limacher,C Giacomantonio,D Zloty,C Murray

doi:10.3747/co.27.6015

Abstract

Non-melanoma skin cancers are the most prevalent form of cancer, with cutaneous squamous cell carcinoma (cscc) being the 2nd most common type. Patients presenting with high-risk lesions associated with locally advanced or metastatic cscc face high rates of recurrence and mortality. Accurate staging and risk stratification for patients can be challenging because no system is universally accepted, and no Canadian guidelines currently exist. Patients with advanced cscc are often deemed ineligible for either or both of curative surgery and radiation therapy (rt) and, until recently, were limited to off-label systemic cisplatin-fluorouracil or cetuximab therapy, which offers modest clinical benefits and potentially severe toxicity. A new systemic therapy, cemiplimab, has been approved for the treatment of locally advanced and metastatic cscc. In the present review, we provide recommendations for patient classification and staging based on current guidelines, direction for determining patient eligibility for surgery and rt, and an overview of the available systemic treatment options for advanced cscc and of the benefits of a multidisciplinary approach to patient management.

Highlights

Non-melanoma skin cancers include both basal cell carcinoma and squamous cell carcinoma—cancers that are more prevalent than all other cancers combined[1]
Cited staging systems include those of the American Joint Committee on Cancer, Brigham and Women’s Hospital, and the U.S National Comprehensive Cancer Network[7,9,10]
A dedicated non-melanoma skin cancer task force developed the ajcc staging manual, currently in its 8th edition, to highlight the staging requirements and high-risk features associated with cscc of the head and neck[9]

Summary

Introduction

Non-melanoma skin cancers include both basal cell carcinoma and squamous cell carcinoma (scc)—cancers that are more prevalent than all other cancers combined[1]. Radiation therapy (rt) is reserved for adjuvant treatment of high-risk tumours or for patients who are not surgical candidates[7]. The predictable pattern of metastasis observed in cscc, in which an estimated 80% of metastases spread first to the regional lymph nodes, suggests that slnb could be a useful technique for evaluating high-risk tumours.

Results

Conclusion